Chapter 1: Skeletal and Soft Tissue Conditions

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dmshaw9
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296667
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Chapter 1: Skeletal and Soft Tissue Conditions
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2015-02-23 22:07:46
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Soft Tissue Conditions
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NPTE Review
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NPTE: Chapter 1
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  1. Osteoporosis: Definition and Characteristics
    • A metabolic disease that depletes bone mineral density/mass, predisposing individuals to fracture
    • Affects women 10x more than men
    • Common sites of fracture = thoracic and lumbar spine, femoral neck, prox humerus, prox tibia, pelvis and distal radius
    • Primary or postmenopausal osteoporosis: directly related to decrease in estrogen production
    • Senile osteoporosis: occurs due to decrease in bone cell activity secondary to genetics/acquired abnormalities
  2. Osteoporosis: Medications
    • Calcium
    • Vitamin D
    • Estrogen
    • Calcitonin
    • Biophosphonates
  3. Osteoporosis: Diagnostic Tests
    • CT Scan: assesses bony density
    • Single and dual photon absorptiometry (very expensive)
  4. Osteoporosis: PT Goals, Outcomes, and Interventions
    • Joint/bone protection strategies
    • Maintain/improve joint mechanics and connective tissue functions
    • Implementation of aerobic capacity/endurance conditioning or reconditioning (aquatic programs)
  5. Osteomalacia: Definition and Characteristics
    • Characterized by decalcification of bones due to vitamin D deficiency
    • Symptoms = severe pain, fractures, weakness and deformities
  6. Osteoporosis: Medications
    • Calcium
    • Vitamin D
    • Vitamin D injections in the form of calciferol (vitamin D2)
  7. Osteoporosis: Diagnostic Tests
    • Plain films
    • Lab tests (urinalysis and blood work)
    • Bone scan
    • Bone biopsy
  8. Osteoporosis: PT Goals, Outcomes and Interventions
    • Joint/bone protection strategies
    • Maintain/improve joint mechanics and connective tissue functions
    • Implementation of aerobic capacity/endurance conditioning or reconditioning (i.e. aquatic programs)
  9. Osteomyelitis: Definition and Characteristics
    • An inflammatory response within bone cause by infection
    • Staphylococcus aureus = usually cause (could be another organism)
    • More common in children and immunosuppressed adults, males > females
  10. Osteomyelitis: Medications
    • Antibiotics
    • Proper nutrition important as well
  11. Osteomyelitis: Diagnostic Tests
    • Lab tests for infection
    • Possibly a bone biopsy
  12. Osteomyelitis: PT Goals, Outcomes, and Interventions
    • Joint/bone protection strategies and cast care
    • Maintain/improve joint mechanics and connective tissue functions
  13. Arthrogryposis Multiplex Congenita: Definition and Characteristics
    • Congenital deformity of skeleton and soft tissues
    • Characterized by limitation in joint motion and a "sausage-like" appearance of limbs
    • Intelligence develops normally
  14. Arthrogryposis Multiplex Congenita: Diagnostic Tests
    Plain films
  15. Arthrogryposis Multiplex Congenita: PT Goals, Outcomes, and Interventions
    • Joint/bone protection strategies
    • Maintain/improve joint mechanics and connective tissue functions
    • Implementation of aerobic capacity/endurance conditioning or reconditioning (aquatics)
    • Application of and patient education regarding adaptive devices, assistive devices, orthotics, and supportive devices
    • Implementation of flexibility exercises to maintain/improve normal joint motion and length of muscles
    • Ongoing communication with family and school important
  16. Osteogenesis Imperfecta: Definition and Characteristics
    • Inherited disorder transmitted by an autosomal dominant gene
    • Abnormal collagen synthesis --> leads to imbalance between bone deposition and reabsorption 
    • Cortical and cancellous bone become very thin, leads to fractures and deformity of WB bones
  17. Osteogenesis Imperfecta: Medications
    • Calcium
    • Vitamin D
    • Estrogen
    • Calcitonin
    • Biophosphonates
  18. Osteogenesis Imperfecta: Diagnostic Tests
    • Bone scan and plain films - show old fractures and deformities
    • Serological testing also indicated
  19. Osteogenesis Imperfecta: PT Goals, Outcomes, and Interventions
    • Joint/bone protection strategies
    • Maintain/improve joint mechanics and connective tissue functions
    • Implement aerobic capacity/endurance conditioning or reconditioning (aquatics)
  20. Osteochondritis Dissecans: Definition and Characteristics
    • Separation of articular cartilage from underlying bone (osteochondral fracture)
    • Usually involves medial femoral condyle near intercondylar notch
    • Observed less frequently at femoral head and talar dome
    • Also affects humeral capitellum
    • Surgical intervention indicated if fracture is displaced
  21. Osteochondritis Dissecans: Diagnostic Tests
    • Plain film
    • CT scan
  22. Osteochondritis Dissecans: PT Goals, Outcomes, and Interventions
    • Joint/bone protection strategies
    • Implementation of flexibility exercises to maintain/improve normal joint motion and length of muscles
    • Implementation of aerobic capacity/endurance conditioning or reconditioning (aquatics)
    • Implementation of strength, power, and endurance exercises
  23. Myofascial Pain Syndrome: Definition and Characteristcis
    • Characterized by clinical entity known as a "trigger point"
    • Onset is hypothesized to sudden overload, overstretching, and/or repetitive/sustained muscle activities
    • Medical interventions may include dry needling (intramuscular manual therapy) and/or injection of analgesic, possibly combined with a corticosteroid
  24. Trigger Points
    • Focal point of irritability found within a muscle
    • Identified as a taut, palpable band within the muscle
    • May be active or latent
    • Active trigger points: tender to palpation, characteristic referral pattern of pain when provoked
    • Latent trigger points: palpable taut bands that are not tender to palpation, but can be conveyed into an active trigger point
  25. Myofascial Pain Syndrome: PT Goals, Outcomes, and Interventions
    • Implementation of flexibility excesses to maintain/improve normal joint motion and length of muscles
    • Manual therapy for maintenance of normal joint mechanics (soft tissue/massage, joint oscillations to reduce pain/muscle guarding, joint mobilizations to correct biomechanical faults caused by joint restrictions, "spray and stretch" technique, dry needling, cryotherapy, thermotherapy, hydrotherapy, sound agents, TENS, manual pressure for desensitization, implementation of strength, power, and endurance exercises)
  26. Tendonosis/Tendonopathy: Definition and Characteristics
    • Common tendon dysfunction
    • Cause and pathogenesis are poorly understood
    • Often referred to as tendonitis though there is no inflammatory response noted
    • Common in may tendons (supraspinatus, common extensor tendon of elbow, patella, Achilles') 
    • Histological characteristics: hypercellularity, hypervascularity, no indication of inflammatory infiltrates, poor organization/loosening of collagen fibrils
  27. Tendonosis/Tendonopathy: Medications
    • Acetaminophen
    • NSAIDs
    • Steroid injection
  28. Tendonosis/Tendonopathy: Diagnostic Tests
    MRI (possibly)
  29. Tendonosis/Tendonopathy: PT Goals, Outcomes, and Interventions
    • Flexibility exercises to maintain/improve normal joint motion and length of muscles
    • Manual therapy for maintenance of normal joint mechanics (soft tissue/massage, joint oscillations, joint mobs)
    • Endurance and strengthening exercise with initial emphasis on eccentric phase of exercise
    • Aerobic capacity/endurance conditioning or reconditioning
    • Thermal agents for pain reduction
  30. Bursitis: Definition and Characteristics
    Inflammation of bursa secondary to overuse, trauma, gout or infection

    • Signs and symptoms:
    • Pain with rest
    • PROM and AROM are limited due to pain but not in a capsular pattern
  31. Bursitis: Medications
    • Acetaminophen
    • NSAIDs
    • Steroid injections
  32. Bursitis: PT Goals, Outcomes, and Interventions
    • Flexibility exercises 
    • Manual therapy (soft tissue/massage, joint oscillations, joint mobilizations)
    • Aerobic capacity/endurance conditioning or reconditioning 
    • Thermal agents for pain reduction, edema reduction, and muscle performance
  33. Muscle Strains: Definition and Characteristics
    • Inflammatory response within a muscle following traumatic event that caused micro tearing of musculotendinous fibers
    • Pain and tenderness within the muscle
  34. Muscle Strains: Medications
    • Acetaminophen
    • NSAIDs
  35. Muscle Strains: Diagnostic Tests
    MRI
  36. Myositis Ossificans: Definition and Characteristics
    • Painful condition of abnormal calcification within a muscle belly
    • Usually precipitated by direct trauma that results in hematoma and calcification of the muscle 
    • Can also be induced by early mobilization and stretching, with aggressive PT following trauma to muscle
    • Most frequent locations = quads, brachialis and biceps brachii muscles
    • Surgical care only warranted in patients with nonhereditary myositis ossificans and only after maturation of lesion (6-24 months)
    • Surgery indicated when lesions mechanically interfere with joint movement or impinge on nerves
  37. Myositis Ossificans: Medications
    • Acetaminophen
    • NSAIDs
  38. Myositis Ossificans: Diagnostic Tests
    • Plain Film
    • CT Scan
    • MRI
  39. Myositis Ossificans: PT Goals, Outcomes, and Interventions
    • Flexibility exercises = avoid being overly aggressive 
    • Manual = avoid being overly aggressive
  40. Complex Regional Pain Syndrome (CRPS): Definition and Characteristics
    • Formerly referred to as reflex sympathetic dystrophy (RSD)
    • Etiology largely unknown, thought to be related to trauma 
    • Thought to be related to trauma
    • Can affected upper and lower extremities, head, trunk, and neck
    • Results in dysfunction of sympathetic nervous system to include pain, circulation, and vasomotor disturbances
    • Long-term changes = muscle wasting, trophic skin changes, decreased bone density, decreased proprioception, loss of muscle strength from disuse, and joint contractures
  41. Two Types of CRPS
    • CRPS I: triggered by tissue injury
    • No underlying nerve injury

    CRPS II: cases clearly associated with nerve injury
  42. Complex Regional Pain Syndrome (CRPS): Medication and Medical Intervention
    • Sympathetic nerve bloock
    • Surgical sympathectomy
    • SC stimulation
    • Intrathecal drug pumps
    • Topical analgesic drugs
    • Antiseizure drugs
    • Antidepressants
    • Corticosteroids
    • Opiods
  43. Complex Regional Pain Syndrome (CRPS): PT Goals, Outcomes, and Interventions
    • Pt/client education for injury prevention and reduction
    • Desensitization activities that focus on return to work/school/home activities
    • Flexibility exercises
    • TENS for pain relief
  44. Paget's Disease (Osteitis Deformans): Definition and Characteristics
    • Etiology largely unknown
    • Thought to be linked to type of viral injection along with environmental factors
    • Metabolic bone disease involving abnormal osteoblastic activity
    • Results in spinal stenosis, facet arthropathy, and possible spinal fracture
  45. Paget's Disease (Osteitis Deformans): Medical Intervention
    • Drug therapy (acetaminophen)
    • Cacitonin and etidronate disodium - limit osteoclast activity (may be helpful)
  46. Paget's Disease (Osteitis Deformans): Diagnostic Tests
    • Plain film imaging - identifies bony changes
    • Lab tests - increased levels of serum alkaline phosphatase and urinary hydroxyproline
  47. Paget's Disease (Osteitis Deformans): PT Goals, Outcomes, and Interventions
    • Joint/bone protection strategies
    • Maintain/improve joint mechanics and connective tissue functions
    • Aerobic capacity/endurance
  48. Idiopathic Scoliosis: Definition and Characteristics
    • Two types: structural and nonstructural (both unknown etiology
    • Structural: irreversible lateral curvature of spine with rotational component
    • Nonstructural: reversible lateral curvature of spine without a rotational component, straightens as individual flexes spine
  49. Idiopathic Scoliosis: Interventions
    • Bracing and possible surgery
    • Harrington rod instrumentation
    • <25 degrees - conservative PT
    • 25-45 degrees, use spinal orthoses
    • >45 degrees - surgery
  50. Idiopathic Scoliosis: Diagnostic Tests
    • Plain film imaging using full-length Cobb's method
    • CT scan and/or MRI (rule out associated conditions)
  51. Idiopathic Scoliosis: PT Goals, Outcomes, and Interventions
    • Flexibility exercises
    • Strength, power, endurance exercises
    • E-stim to improve muscle performance
    • Application and education on spinal orthoses
  52. Torticollis: Definition and Characteristics
    • Spasm and/or tightness of SCM with varied etiology
    • Sidebent toward and rotated away from affected SCM
  53. Torticollis: Medications
    • Acetaminophen
    • Muscle relaxants
    • NSAIDs
  54. Torticollis: PT Goals, Outcomes, and Interventions
    • Flexibility exercises
    • Manual therapy (soft tissue/massage, joint oscillations, joint mobilizations)

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